Understanding Breakthrough Pain

Understanding Breakthrough Pain

If you’re living with pain, then you know that achieving relief can be a long process. Sometimes – just when you and your health care provider believe you’ve succeeded in finding the right treatment to control your pain – you may experience a phenomenon called breakthrough pain. Breakthrough pain comes on rapidly, lasts from three to 30 minutes and can occur at any time.1

These flare-ups are especially problematic because they “break through” the medication you are taking or treatments you are undergoing to ease or stop your pain. Researchers estimate that more than 80% of people taking long-acting medication for chronic pain experience breakthrough pain. 2

There are three different types of breakthrough pain:

•Incident pain – which occurs with or following physical activity, •End-of-dose failure – which occurs in the time before you are supposed to take your next dose of medication •Spontaneous breakthrough pain – which occurs without predictable cause or frequency3 Keep track of the timing and possible causes of your breakthrough pain to help you and your provider pinpoint which type you are experiencing.

Treating Breakthrough Pain

Breakthrough pain is different than persistent (or chronic) pain and requires different treatment.4 While persistent pain is often treated using a combination of long-lasting medications, breakthrough pain is treated with medications that take effect quickly and last only as long as your typical breakthrough pain episode.5 Medication for breakthrough pain can be taken in a number of ways including by injection; sublingually, which means the medication dissolves under your tongue; rectally; or transmucosally, which means the medication is absorbed in your mouth through your cheek.

While short-acting opioid pain medicines taken by mouth are sometimes prescribed for breakthrough pain, they may not be the best choice because they can take 30 to 60 minutes to be absorbed by the central nervous system and “kick in.” 6 Medications designed for persistent pain, such as sustained release or long-acting opioids, take longer to begin working but provide pain relief for hours. Unfortunately, increasing the dose of such medications will not relieve breakthrough pain because they are designed to enter the bloodstream at a steady and controlled rate. In addition, increasing the dose of these types of medications can be dangerous and may lead to more side effects, such as constipation, sedation, or confusion.7 You should never increase or adjust your dosage of any medications without first speaking to your health care provider.

Steps to Take

If you haven’t already, schedule an appointment with your health care provider to talk about your breakthrough pain and find out more about treatment options. Remember that everyone experiences pain differently and responds to medication differently. You may have to try a variety of medications and ways to take the medication before you find a treatment that brings relief.

Be sure to track when breakthrough episodes occur by keeping a journal of your experiences, including when you hurt least and when you hurt most, what medications or activities help control your pain, and what treatments work best. Also note what activities or situations seem to activate your breakthrough episodes. Access an online Personal Pain Journal, from the National Pain Foundation, where you can record your day-to-day experiences with pain and pain management. Keeping a journal will help you remember valuable information you need to share with your health care provider to effectively manage your condition.

You might also consider alternative or complementary treatments for your pain. Massage, Reiki, acupuncture, yoga and relaxation therapies such as biofeedback, hypnosis and imagery may help you cope with breakthrough episodes. The National Pain Foundation offers several articles regarding alternative and complementary treatments.

Lastly, don’t be afraid to be honest with your friends, family members and health care providers about your pain. Without understanding and treatment, breakthrough pain can interfere with your daily activities, disrupt your sense of well-being, and even make it more difficult to treat your persistent pain.8-11

Resources 1.RK Portenoy, N A Hagen, “Breathrough pain: Definition, prevalence and characteristics,” Pain 41 (June 1990) 273-281 2.PG Fine, M A Busch, “Characterization of breakthrough pain by hospice pateints and their caregivers,” Journal of Pain and Symtpom Management 16 (September 1998) 179-183 3.Management of Cancer Pain, Clinical Practice Guideline, Number 9 (washington, DC: US Department of Health and Human Serivces, AHCPR Publication No. 94-0592, March 1994). 4.Ibid. 5.RK Portenoy, N A Hagen, “Breakthrough cancer pain: Definition and manifestations,” Primary Care & Cancer (April 1991) 27-33. 6.Ibid. 7.M A Simmonds, “Management of breakthrough pain due to cancer,” Oncology 13 (August 1999) 1103-1108, review: 1110-1114. 8.C S Cleeland et al, “Pain and its treatment in outpatients with metastatic cancer,” New England Journal of Medicine 330 (March 3, 1994) 592-596. 9.N Coyle et al, “Character of terminal illness in the advanced cancer patient: Pain and other symptoms during the last four weeks of life,” Journal of Pain and Symptom Management 5 (April 1990) 83-93. 10.E Bruera et al, “A prospective multicenter assessment of Edmonton staging system of cancer pain,” Journal of Pain and Symptom Management 10 (July 1995) 348-355. 11.S Mercadante et al, “Pain characteristics of advanced lung cancer patients referred to a palliative care service,” Pain 59 (October 1994) 141-145.



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